Provider Demographics
NPI:1952632283
Name:WATKINS, BONNIE LOU (RN)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:LOU
Last Name:WATKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 BREESPORT RD LOT 109
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:NY
Mailing Address - Zip Code:14838-9761
Mailing Address - Country:US
Mailing Address - Phone:607-739-5891
Mailing Address - Fax:
Practice Address - Street 1:221 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2721
Practice Address - Country:US
Practice Address - Phone:607-734-3646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290713-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health